Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F341740 | NY |
NPI | 1003342056 |
---|---|
Provider Name | Mrs. Molly Sue Kim |
First Address | New York, NY 10017-5699 |
Second Address | New York, NY 10029-6030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 02/12/2019 |